Mitochondrial Dysfunction as a Contribution to Atrial Fibrillation
This paper is an example of work exploring how exactly mitochondrial dysfunction might contribute to age-related atrial fibrillation, the dysregulation of heart rhythm. It is possibly more helpful as an introduction to the roots of atrial fibrillation, meaning dysfunction in electrical connectivity and remodeling of structure in heart tissue, and how those two issues relate to one another. A perhaps surprisingly large fraction of atrial fibrillation can be at least temporarily corrected via minimally invasive surgical techniques, because in those cases the issue arises from inappropriate electrical signaling originating in small areas of the heart and connecting vessels, but once age-related changes in the heart become more widespread and severe, this stops being the case.
Atrial fibrillation (AF) is a common arrhythmia in clinical practice that often leads to severe complications such as heart failure, myocardial infarction, and stroke. It is associated with increased mortality and a significantly reduced quality of life. Current treatments for AF include risk factor control, medications for rate and rhythm control, and anticoagulation. For refractory cases, interventional procedures like cardiac radiofrequency ablation are used. However, these treatments have limitations, including adverse effects such as bleeding and a significant risk of AF recurrence. Further elucidating the mechanisms of AF development and identifying precise intervention targets are urgently needed.
The pathogenesis of AF has not been fully elucidated, but the core pathological basis for its development and maintenance primarily involves two major mechanisms: atrial electrical remodeling and structural remodeling. Electrical remodeling is mainly manifested as abnormal ion channel function in atrial myocytes, resulting in a shortening of action potential duration and increased dispersion of the effective refractory period. This creates a substrate for reentrant arrhythmias. Structural remodeling, on the other hand, involves morphological changes such as atrial fibrosis, myocardial hypertrophy, and dilation, which further promote the persistence and stabilization of AF.
Recent studies have confirmed that mitochondrial dysfunction is a central hub driving these remodeling processes. As the energy factories of the cell, mitochondria generate adenosine triphosphate (ATP) through oxidative phosphorylation, providing the necessary energy for sustained contraction, ion pump operation, and electrical signaling in cardiomyocytes. In the AF state, atrial myocytes are subjected to rapid, disorganized, high-frequency electrical excitation. The dramatic increase in energy demand leads to mitochondrial overload and accelerates mitochondrial senescence and damage.
Mitochondrial dysfunction affects intracellular ionic homeostasis and membrane excitability through dual disruptions of energy crisis (ATP insufficiency) and oxidative stress (reactive oxygen species burst). These disruptions directly impair cardiomyocyte ion channel function and expression, driving the onset and progression of AF. Mitophagy, a key mechanism for mitochondrial quality control, selectively removes damaged mitochondria to prevent reactive oxygen species accumulation and preserve the healthy mitochondrial network. However, chronic AF-related stress (e.g., calcium overload, sustained reactive oxygen species exposure) can impair mitophagy pathways, resulting in the accumulation of dysfunctional mitochondria.
This study combined bioinformatics analysis and experimental validation to uncover key genes and molecular networks underlying the interaction between mitophagy and ion channels in AF. The objective was to elucidate the molecular mechanisms underlying the "mitophagy defects -> ion channel dysfunction -> electrical remodeling" axis.